Key result
Impaired GLS is linked to ~7.2-fold higher odds of post-AVR adverse LV remodeling in women.
Why the study?
GLS, BNP, and the E/E′ ratio provide prognostic information before AVR in asymptomatic severe AS with preserved EF, but uniform cut offs may overlook sex differences. This study investigated sex-specific thresholds within an integrated risk model to predict adverse LV remodeling and MACE after AVR.
Do sex-specific thresholds for GLS, BNP, and E/E′ improve the prediction of adverse left ventricular remodeling and major adverse cardiovascular events in patients with asymptomatic severe aortic stenosis and preserved ejection fraction undergoing aortic valve replacement?
Cohort (n=116)
No
Do sex-specific thresholds for GLS, BNP, and E/E′ improve the prediction of adverse left ventricular remodeling and major adverse cardiovascular events in patients with asymptomatic severe aortic stenosis and preserved ejection fraction undergoing aortic valve replacement?
Sex-specific thresholds for GLS, BNP, and E/E′ refine risk stratification for adverse LV remodeling and MACE after AVR in asymptomatic severe aortic stenosis, demonstrating that women experience risk at more impaired GLS, higher E/E′, and lower BNP levels than men.
Background Preserved ejection fraction (EF) can mask subclinical dysfunction in asymptomatic severe aortic stenosis (AS). Global longitudinal strain (GLS), B-type natriuretic peptide (BNP) and the E/e′ ratio (E/E′) provide prognostic information before aortic valve replacement (AVR), but uniform cut offs may overlook sex differences. Building on our previous study that for the first time defined cut off values for these parameters in asymptomatic severe AS with preserved EF, we now investigate sex specific thresholds within an integrated risk model. Purpose To explore sex specific thresholds for GLS, BNP and E/E′ and validate their predictive value in a longitudinal risk model for adverse left ventricular (LV) remodeling and major adverse cardiovascular events (MACE) after AVR. Methods This substudy expands our previously published cohort of 96 patients by including additional female patients, resulting in 116 patients with severe asymptomatic AS and preserved EF (>50%) who underwent AVR (60% men, 40% women). Echocardiography (GLS, EF, LV mass index [LVMI], interventricular septal diameter [IVSd], LV internal diameter in diastole [LVIDd], E/E′), BNP and clinical outcomes were assessed at baseline and 1, 3 and 6 months. Primary endpoint was LV remodeling; secondary endpoint MACE. Results Women had smaller LV dimensions but higher relative wall thickness. Impaired GLS (<15) was frequent in both sexes (74% men vs. 80% women). At 6 months, negative remodeling persisted more in men (68% vs. 57%), while GLS >15 predicted favorable remodeling, stronger in women (OR 7.2, p=0.018). For MACE, E/E′ was predictive in men (OR 3.45, p=0.003), BNP in women (OR 1.01 per 10 pg/ml, p=0.041). ROC analysis confirmed prognostic value of GLS, BNP and E/E for adverse remodeling and MACE in both sexes, with sex related differences in optimal thresholds. GLS showed strong discrimination in women (AUC 0.85, optimal cut off ≤14) and men (AUC 0.80, optimal cut off ≤15). BNP remained predictive in men (AUC 0.70, cut off 200 pg/ml) and in women at lower thresholds (150 pg/ml). E/E′ demonstrated strong discrimination in men (AUC 0.84, cut off 13) and moderate but significant discrimination in women (AUC 0.72, cut off 15). MACE occurred more frequently in men (27%) than in women (15%), but at higher (more impaired) GLS thresholds, lower BNP thresholds, and higher E/E′ thresholds in women. Conclusion Women with asymptomatic severe AS exhibit negative remodeling and increased risk of MACE at more impaired GLS thresholds, higher E/E′ thresholds, and lower BNP thresholds compared with men as identified within our integrated model. Sex-specific thresholds refine risk stratification and guide individualized timing of AVR. These findings, supported by our sex- specific integrated GLS–BNP–E/E′ model, warrant multicenter validation.
No takes yet. Share an insight, caveat, or question.
Sehovic et al. (2026) conducted a cohort in Asymptomatic severe aortic stenosis with preserved ejection fraction (n=116). Sex-specific thresholds for GLS, BNP, and E/E' (Women vs. Men) vs. Men vs. Women / uniform cut-offs was evaluated on Left ventricular (LV) remodeling (OR 7.2, p=0.018). Sex-specific thresholds for GLS, BNP, and E/E' strongly predicted LV remodeling and MACE after AVR (GLS AUC 0.85 in women vs 0.80 in men; GLS >15 OR 7.2, p=0.018 in women).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: